Advances in health services research are informing health system change and guiding strategies to improve the quality and outcomes of healthcare delivery. Unfortunately, these advances are occurring without adequate attention to children. The characteristics of childhood as a unique developmental stage of life, the continuity of child and adult health, and a distinctive child healthcare system justify the need for a separate health services research focus on children. This application builds on Dr. Forrest's work in child health services research, managed care, and child health status assessment. His long-term career goal is to conduct research that leads to improvements in the delivery of health care services to children and adolescents. Forrest's research and career development plans benefit from a rich environment of colleagues, support staff, and sophisticated computing equipment in the Health Services Research and Development Center at John Hopkins School of Public Health. The applicant's research goals are (1) to improve our understanding of the mechanisms by which managed care influences children's access to medical care, specialty care service use, and healthcare expenditures, (2) to develop and empirically test a conceptual model of child health and its linkages with healthcare services, and (3) to examine the impact of alternative models of primary-specialty care collaboration on quality, costs, and outcomes for children with chronic and mental health disorders. These goals will be met by expanding funded research activities, developing new projects that are logical extensions of ongoing work, establishing partnerships with insurers, providers, and academic colleagues, getting new expertise in the statistical analysis of multi-level study designs and in cost-effectiveness research, and mentoring trainees and faculty pursuing work in child health services research. An Independent Scientist Award at this stage in the applicant's career will release him from administrative and teaching responsibilities so as to provide the time and resources needed to intensify and expand his work in child health services and outcomes research.